撒哈拉以南非洲地区 HIV 阳性青少年中 HIV 诊断披露与抗逆转录病毒治疗依从性之间的关联：系统评价和荟萃分析。

The association between HIV diagnosis disclosure and adherence to anti-retroviral therapy among adolescents living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis.

机构信息

School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.

School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.

出版信息

PLoS One. 2023 May 11;18(5):e0285571. doi: 10.1371/journal.pone.0285571. eCollection 2023.

INTRODUCTION

Nine in ten of the world's 1.74 million adolescents living with human immunodeficiency virus (ALHIV) live in Sub-Saharan Africa. Suboptimal adherence to antiretroviral therapy (ART) and poor viral suppression are important problems among adolescents. To guide intervention efforts in this regard, this review presented pooled estimates on the prevalence of adherence and how it is affected by disclosure of HIV status among ALHIV in Sub-Saharan Africa.

METHODS

A comprehensive search in major databases (Excerpta Medica database (EMBASE), PubMed, Ovid/MEDLINE, HINARI, and Google Scholar) with additional hand searches for grey literature was conducted to locate observational epidemiologic studies published in English up to November 12, 2022 with the following inclusion criteria: primary studies that reported disclosure of HIV status as an exposure variable, had positive adherence to ART as an outcome, and conducted among adolescents and children. The COVIDENCE software was used for a title/abstract screening, full-text screening, the JBI quality assessment checklist, and data extraction. Random effects model was used to pool estimates. Furthermore, sensitivity analysis and subgroup analysis were also conducted by age groups and type of adherence measures used.

RESULTS

This meta-analysis combines the effect estimates from 12 primary studies with 4422 participants. The prevalence of good adherence to ART was 73% (95% CI (confidence interval): 56 to 87; I2 = 98.63%, P = <0.001), and it was higher among adolescents who were aware of their HIV status, 77% (95% CI: 56 to 92; I2 = 98.34%, P = <0.001). Overall, knowledge of HIV status was associated with increased odds of adherence (odds ratio (OR) = 1.88, 95% CI: 1.21 to 2.94; I2 = 79.8%, P = <0.001). This was further supported in a subgroup analysis by age (seven studies, pooled OR = 1.89, 95% CI: 1.06 to 3.37; I2 = 81.3%, P = <0.0001) and whether primary studies controlled for confounding factors (six studies provided adjusted estimates, pooled OR = 2.61, 95% CI: 1.22 to 5.57; I2 = 88.1%, P = <0.001) confirmed this further.

CONCLUSIONS

Our meta-analysis and systematic review revealed that knowledge of one's HIV status was associated with adherence to ART, particularly among adolescents. The findings underscored the importance of encouraging disclosure in order to enhance adherence among adolescents.

简介

全球 174 万艾滋病毒感染者（ALHIV）中，有十分之九生活在撒哈拉以南非洲。在青少年中，抗逆转录病毒疗法（ART）依从性不足和病毒抑制不佳是重要问题。为了指导这方面的干预工作，本综述提供了撒哈拉以南非洲 ALHIV 中 HIV 状况披露对依从性的影响的综合估计。

方法

在主要数据库（EMBASE 数据库、PubMed、Ovid/MEDLINE、HINARI 和 Google Scholar）中进行全面检索，并对灰色文献进行额外的手工检索，以查找截至 2022 年 11 月 12 日发表的以英语发表的观察性流行病学研究，纳入标准为：报告 HIV 状况披露作为暴露变量的主要研究、将积极的 ART 依从性作为结局变量，并在青少年和儿童中进行的研究。使用 COVIDENCE 软件进行标题/摘要筛选、全文筛选、JBI 质量评估清单和数据提取。使用随机效应模型汇总估计值。此外，还按年龄组和使用的依从性测量类型进行敏感性分析和亚组分析。

结果

本荟萃分析合并了 12 项初级研究和 4422 名参与者的效应估计值。ART 良好依从性的流行率为 73%（95%置信区间：56 至 87；I2=98.63%，P<0.001），在知晓 HIV 状况的青少年中更高，为 77%（95%置信区间：56 至 92；I2=98.34%，P<0.001）。总体而言，对 HIV 状况的认识与更高的依从性几率相关（比值比（OR）=1.88，95%置信区间：1.21 至 2.94；I2=79.8%，P<0.001）。这在按年龄（七项研究，汇总 OR=1.89，95%置信区间：1.06 至 3.37；I2=81.3%，P<0.0001）和初级研究是否控制混杂因素（六项研究提供了调整后的估计值，汇总 OR=2.61，95%置信区间：1.22 至 5.57；I2=88.1%，P<0.001）的亚组分析中进一步得到证实。